Study The Performance Evaluation And Policy Suggestions Of Urban And Rural Residents’ Critical Illness Insurance

After the basic medical insurance reimbursement, urban and rural residents’ critical illness insurance (Hereinafter referred to as "the critical illness insurance ") further reimburse the high and compliance medical expenses of patients with critical illness. It is a transition phase from the pilot stage to the full implementation of the stage for the critical illness insurance. It is very important to research and evaluation of the critical illness insurance system. In order to find the experience and problems, further improve the system of the critical insurance, this paper tries to establish evaluation index system and uses the city of Taicang Suzhou Suqian Sheyang as a case study for researching the system design and implementation of the critical illness insurance condition by case analysis and comparative analysis.First, this paper builds an evaluation index system of the critical insurance under the principle of fairness, efficiency and development. Fairness index’ secondary indicators include the unitize level, equivalence relations of rights and obligations. Efficiency index’ secondary indicators include medical burden, beneficiaries and management effectiveness. Development index’ secondary indicators include system independent and cohesion. It also sets the three-level indicators and measures of the above several indicators. By reference to the evaluation index system above, this paper analysis the fairness, efficiency and development of the critical illness insurance in four areas. The study finds that the critical illness insurance’s system design and implementation in Taicang basically realized the equity, efficiency and sustainable development, the system of the three other cities and counties both have some shortcomings in fairness, efficiency and development.Summarizing the experience of the four areas can be found that improving the overall level can help each other in all aid; In the beginning of the critical illness insurance, it should draw lessons from Taicang city which adopting a reimbursement policy of "sound and safe"; Appropriately raising the reimbursement level of rural residents can make up for the unequal starting point. At the same time there also are the following problems, such as reimbursement policy lacks of effectiveness and fairness in the design; The medical burden of gap between regions, also between urban and rural areas is still bigger; The financing channel is single and lacks of independence; The fund level is low and fund strength is poorer; There is no effective cooperation and supervision mechanism between government and commercial insurance company; It lacks of effective cohesion between insurance and medical treatment of the critical illness.The goal of the critical illness insurance is to improve the fairness, efficiency and development under the perspective of integration. Designing the critical illness insurance system should follow the principle of complementary and extensibility, special privilege, the integration of the worker, urban and rural residents, the government leading and companies participating in. It’s necessary to unitize the worker, urban and rural resident’s critical illness insurance and appropriate tilt to rural residents in reimbursement policy; To set a reasonable reimbursement policy of the critical illness insurance; To improve the independent and sustainability of financing mechanisms; To further improve the normative and effective of cooperation and supervision between government and commercial insurance companies; To improve the effectiveness of cohesive mechanism between the critical illness insurance and medical treatment.